The Republicans may have lost the battle to repeal the Affordable Care Act (ACA), but their war on our access to medical care will certainly continue. Donald Trump and Paul Ryan are determined to dismantle the social safety net, and health care funding is their central focus.
Trump openly states that he wants the ACA to collapse, and there are some key aspects of “Obamacare” that need to be defended, such as the expansion of coverage via Medicaid and children up to age 26 and the ban on denying insurance based on pre-existing medical conditions.
But the reality is that the ACA is a completely inadequate solution to our broken health care system. It mandates severe cuts to Medicare and funding to hospitals for the uninsured, and it shovels money to insurance companies while still leaving 28 million people without health insurance. Now many insurance companies have pulled out of the ACA, making even a “high cost/bad coverage” insurance plan more difficult to get.
In response to the bleak debate between the Democrats’ shoddy ACA and the Republicans’ proposals for even worse, there has been growing support for a government-run “Medicare for all” system that makes health care a basic right and not a matter of profit.
This is an important development that has received a lot of media attention. But what’s received less attention is the growing organization and militancy of the heath care workers — particuarly nurses — whose unions have the power to both win better care for their patients on a local level and be the driving force for a national health care reform movement.
Health care workers are the ones who titrate medication drips, clean bowel movements and comfort families, and who shoulder the emotional, physical and psychological work that makes hospitals run, yet they are left out of the discussion of who gets care, when they get it and how the care will be designed.
Nurses daily coordinate every patient’s care with other health care professionals — doctors, social workers and pharmacists — as well as transporters, ward clerks and lab technicians. Because of this key role, nurses’ strikes have a disproportionate impact on the running of hospitals which cannot function properly without them.
As health care has become a more central part of the U.S. economy, hospital unionization rates have increased — in stark contrast to the declining numbers of the larger labor movement.
Union membership in hospitals grew from 13.8 percent in 2000 to 14.3 percent in 2010. “Although the growth in density might seem modest,” writes labor analyst Kim Moody, “it was nonetheless significant as union density in hospitals was twice that for the private sector workforce as a whole.”
Nurses are at the forefront of this trend: In 2014, 17 percent of registered nurses and 11 percent of licensed practical nurses were unionized.
Organized nurses have tremendous potental to use collective action to win improved staffing and safety for themselves and their patients, as well as improved wages and benefits. Hospital corporations are well aware of this, of course, and many have gone on the offensive in recent years against their employees.
Last month, Tufts Medical Center in Boston imposed a four day lockout on its 1200 nurses in the Massachusetts Nurses Association, in retaliation for the nurses’ one-day strike over patient safety, staffing levels and cuts to wages. Tufts spent $6 million on replacement nurses but offered no money to meet the nurses’ concerns.
The battle at Tufts comes on the heels of two 2016 strikes involving 4800 members of the Minnesota Nurses Association at Allina Hospital, which sought to strip nurses of their health care. Allina spent $104 million to bring in scab nurses during that time.
The strikes at Allina and Tufts have inspired health care workers, but in both cases nurses returned to work with questionable contract gains and financial hits taken by both the union and the members.
The lesson to be taken from these heroic efforts is not that nurses shouldn’t strike or that they can’t win, but that — like working people everywhere — they’re up against cold-hearted corporations and need to be clear about the issues they’re fighting for and what it will take to win them.
What gives nurses a potential advantage over many other workers is that health care a highly politicized industry. Strikes by nurses and other hospital workers can shine a light on the miserable conditions being created in hospitals every day by the for-profit health care system — and rally public support both for the strikers and for larger reform.
One common argument made hospital CEOs during a nurses’ strike is that the workers are prioritizing their own needs over their patients and violating the pledge all health care workers take to “do no harm.”
The idea that nurses organizing to strike are going to simply abandon their patients mid-shift is preposterous, and it’s especially rich coming from health care managers who talk about their patients as “clients.”
Hospital bosses present a moralistic and self-serving vision of nurses and other health care workers as servants who are there to provide a good patient experience first, and medical care second for patients — with no agency over how their workplace is run.
In reality, the constant pressure coming from above to cut costs, drive down wages and benefits and slash staffing reveals the empty morality of management and foces nurses to collectively organize for their patients and themselves. “Safe staffing” has beome a key demand in most contract negotiations and strikes.
The Massachusetts Nurses Association emphasized the centrality of its demand for better staffing by calling its walkout a “Patient Safety Strike.” Striking nurses held signs with slogans that read, “Tufts Patients Deserve Safe Care” and “Tufts RNs Protecting Patient Care.”
Similarly, during the Allina strike, striking nurse Gail Olson told Labor Notes, “Our number one issue is staffing. Allina is refusing to agree to a staffing proposal that actually adds staff.”
It’s obvious to nurses that better staffing leads to better patient outcomes, and their feeling is backed up by research. A 2014 study from the British medical journal The Lancet found an increase in a nurse’s workload by just one additional patient increased the likelihood of a patient in that hospital dying by 7 percent.
In other words, it is striking nurses who are the ones fighting for patients, and hospital bosses who put their own selfish interests above those of their “clients”.
Nothing makes this clearer than hospitals’ dangerous use of replacement nurses as scab labor during a strike.
During a strike at St. Vincent Hospital, in Worchester in 2000, “three replacement nurses recruited by the same strike replacement nurse agency Tufts plans to use were fired after separate incidents in which they left a patient alone after surgery …gave the wrong baby to a nursing mother,” according to the Massachusetts Nurses Association. “Another patient was given a nearly fatal overdose of morphine because a replacement nurse misunderstood a doctor’s order.”
Similar incidences occurred in the Allina strikes, compelling one replacement nurse to quit and join the strking nurses on their picket line. Explaining her decision to the Star-Tribune, the nurse said,”There are some nurses working out of the scope of their practice that are completely lost.”
When nurses strike over staffing, it can strengthen the relationship between patients and nurses. It is through this social connection, much like the one between students and teachers, that a common struggle for both better care and better working conditions can be forged.
But nurses and other healthcare workers also have a right to a safe and respectful workplace. The issue of safety in hospitals is centered primarily on patients. While patient safety is obviously critical, workplace safety for nurses often takes a backseat.
Whether it’s physical injuries, exposure to communicable diseases or the daily grind of seeing people at their worst moments, nurses are supposed to “suck it up,” ignore the pain and take care of patients. There are few other jobs where it is routine to be bitten, punched, kicked and verbally abused on a daily basis with few protections.
According to data from the Occupational Health and Safety Administration (OSHA), Bureau of health-care workers experience the most nonfatal workplace violence compared to other professions by a wide margin. A 2014 study in the Journal of Emergency Nursing found almost 80 percent of nurses reported verbal and physical abuse on the job from patients and visitors within the past year.
For many nurses, this violence intersects with the daily sexism they experience on the job. Female health care workers are often the victims of sexual harassment from physicians, administrators, managers and patients. More than fifty percent of female nurses say they have been sexually harassed.
The sexism faced by nurses isn’t just interpersonal but institutional. Over the last several decades, nursing has attracted more men because it’s a growing field with the prospect for higher hourly wages, benefits and stability. But even as more men enter the profession, 90 percent of nurses still being women.
Yet the gender pay gap between male registered nurses and their female counterparts has not narrowed. In fact, male hospital nurses make almost $4000 more per year than female nurses with similar positions.
The struggle against sexism and for equal pay should be central to improving the conditions that healthcare workers face daily.
Like all workers, nurses face an unrelentingly hostile force in the Trump White House.
Public-sector nurses unions face the potential of national “right-to-work” union-busting if the Supreme Court, stacked with conservative judges, rules against unions in Yohn v. California Teachers Association and Janus v. AFSCME.
Trump’s new appointees to the National Labor Relations Board (NLRB) may revive the 2006 Kentucky River cases to declare that because nurses delegate work to other licensed and ancillary staff, they are supervisors and therefore inelibigle for unionization.
Within this context, nurses’ unions must be defended as they remain the key organizations by which nurses can speak out for themselves and their patients, against the onslaught of profit-driven work flow management schemes.
Organized nurses are the most powerful force for resisting the power of for-profit insurance companies, pharmaceutical corporations and the American Hospital Association — and it’s bought off backers in both political parties.
A recent Associated Press survey found that 62 percent say it is the federal government’s responsibility to make sure that all Americans have healthcare coverage. But health care workers and their patients can’t depend on a two party system to legislate away a $3 trillion dollar industry.
Nurses and other health care workers have the potential to democratically put forward a different vision of free health care for all, provided in safe, clean and well-staffed hospitals. For this to happen, nurses will need to show that they have the organization and ability to strike for themselves, their patients and their community.
Danny Katch contributed to this article.